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The Work-to-Work program at the Western Michigan University Unified Clinics serves young adults who have diagnoses such as autism, asperger syndrome, learning disability, cognitive impairment and other mental health disorders. Referral sources include Michigan Rehabilitation Services, local intermediate school districts and private referrals. The focus of the adult Work-to-Work program is the development of higher-level independent living skills including work and appropriate workplace communication/interpersonal skills. Through evaluation, program helps to determine the adult client’s potential for independent living and for employment. Intervention is designed to improve independent living skills and prevocational skills through participation in therapeutic social and task groups, one-on-one supervision during work activities and one-on-one sessions to target specific skill areas for the individual client.

The role of the occupational therapy interns, under supervision of the licensed occupational therapist, includes providing in- depth evaluation, and designing client-centered intervention directed toward improving independent living, communication/socialization skills and prevocational skills. Interns will be guided in developing client-centered and occupation-based intervention plans supported by appropriate theoretical approaches and empirical evidence. Interns will also establish a strong therapeutic relationship based upon client-centered principles and guided by the theoretical concepts from the Model of Human Occupation.

Client evaluation process

The evaluation is scheduled over four 2.5 hour sessions and consists of interview, standardized assessments, and structured observations of work- related behavior including skills in workplace socialization and task performance. While the primary focus of the evaluation is on client psycho-social factors, screens are also provided to identify issues that may impact work or independent living skills in the areas of gross motor and fine motor, visual motor integration, sensory motor, and sensory integration. The evaluation identifies strengths, needs, and potential related to independent living and employment and provides recommendations for services and interventions to prepare the client for the least restrictive living situation and for the recommended level of employment.

Students administer the following formal and informal evaluations:

• Assessment
• Interviews
  • Occupational profile interview
  • Worker role interview/OCAIRS
• Observations
  • Assessment of communication and interaction skills
• Self-assessments
  • Interest checklist
  • Role checklist
  • Occupation self-assessment
• Performance capacity/self-care/independent living skills
  • Visual screening
  • Functional range of motion
  • Functional manual muscle testing
  • Balance and equilibrium
  • Pinch and grip strength
  • Modified assessment of motor and process skills
  • Nine hole peg test
  • Adult sensory profile
  • Independent living skills
  • Beery-Buktenica Developmental Test Visual-Motor Integration

Client intervention process

Intervention is scheduled for 2.5 hour, twice weekly sessions. Intervention is designed to improve independent living skills, communication and interaction skills, and vocational skills through participation in therapeutic social and task groups, one-on-one supervision during work activities and one-on-one sessions to target specific skill areas for the individual client. An individualized intervention plan is developed in collaboration with the client and any individuals identified as significant by the client. Although each client will have a specific focus of intervention, in general the independent living skills program emphasis will be toward developing skills needed to live as independently as possible with the least amount of supports in place. Skills will be developed in the Work-to-Work program with the expectation of immediate follow-through in the home environment. The vocational skills program places emphasis on developing skills in work-behaviors including communication and interactions appropriate to the workplace. Through the therapeutic alliance with the OT and OT intern, clients will develop performance-based self-awareness essential to the process of realistic goal development and for guided self- improvement of work behavior and skills. Through the use of self-assessment tools and feedback from OT and OT interns, clients will learn compensatory strategies to improve performance at home and in the work setting. In addition to the Model of Human Occupation as the guiding theoretical structure, the following Frames of Reference/treatment approaches may be used to guide intervention: cognitive-behavioral, occupational adaptation and self-awareness enhancement through learning and function. Additionally, the M. Cole 7-step format for group process is used to guide structured therapeutic groups.

By the end of the semester it is expected that students will have developed the following basic competencies regarding working with for young adults with mental health disorders:

• Evaluation and intervention process

• Building therapeutic relationship and therapeutic use of self

• Developing client-centered and occupation-based intervention plan supported by appropriate theoretical approaches and empirical evidence

• Providing intervention directed toward improving independent living, communication and interaction skills, and prevocational skills

• Implementing one-on-one and group intervention